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All is not lost when your Medicare Advantage plan terminates your coverage.
Recently, thousands in the Philadelphia area (and other areas) have been notified that their Medicare Advantage plan will terminate as of 12-31-09. While this may be particularly harsh to those on some low premium plans, subscribers in PPO's are finding they may actually be better off.
Depending on you age, and where you live, Medicare Advantage PPO subscribers are finding that a Medicare Supplement plan, also called "Medigap" may be comparable in price, have no co-pays, no doctor networks, and better out of network coverage than they had before. Many are actually saving money when combined with the proper Medicare prescription drug plan.
While it's not true in every case most people we've talk to have been satisfied if not thrilled at the outcome. We would recommend calling the SENIOR ADVISORS GROUP for help and more details. They operate in 11 states with more being added to accommodate terminated Medicare Advantage subscribers. And, since they offer all the top Medicare supplement providers they can reccommend the lowest cost Medicare Supplement plan available in your area. They have also indicated that a new – major - Medicare Supplement provider will launch its Medicare Supplemental Insurance in 32 states on November 1st. I’m told it will be a well recognized brand providing Medigap insurance at - or near - the low end of Medicare supplement premiums in most areas. So with all the stress over terminated Medicare advantage plans, there may be a silver lining, and change in your pocket.
Friday, October 9, 2009
Saturday, October 3, 2009
Medicare Supplemental Plans for 2010
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Beginning June 1st, 2010 Medicare Supplemental Insurance (Medigap) will include two new choices for consumers - Medicare Supplement Plan M and Medicare Supplement Plan N.
At that time Medigap will eliminate plans E, H, I, and J as the "Preventive Care Benefit" and the "At-home-Recovery" benefit are removed. Once removed these plans – E, H, I, And J – will become identical to other lettered Medicare Supplement plans and thus redundant. Medicare has deemed these two benefits unnecessary in the current Medicare structure. In addition to these changes, a hospice care benefit Co-insurance coverage will be added to all new Medicare Supplement Plans.
Current Medicare Supplement policy holders will be permitted to keep existing Medicare Supplement Insurance policies, however as of June, 2010 enrollment will cease into ALL current plans. It is not necessarily beneficial to purchase one plan over another (purchase the one that fits) because all plans purchased after June 1st will be in the "New" Medicare Supplement Plan policy design. Existing Medicare Supplement policies (Policy holders) will be partitioned into one group and plans purchased after June will be partitioned into new policy groups. However, it is not certain that all Medicare Supplement (Medigap) providers will offer the new plans N and M, so a qualified, independent, advisor is suggested. Since most insurance carriers offer several plans it is important to shop around for the best price. (For more help go to Medicare Advisor)
An independent Medicare Supplement Advisor can assist you in finding a plan now; as well as help in 2010 when the new plans roll out. For individuals turning 65 before June 2010 the independent Advisor will be able to suggest a plan today as well as provide service and alternatives next year when the new plans and premiums become available. Company employed agents may not be the best solution as they can only suggest their companies plans. The Senior Advisors Group (Link) represents most plans in a given area and is very helpful in explaining the various options available today and the new plans coming next year. (including Medicare Advantage) Search Medicare Plans in your area
New Medigap Plan Design
Medicare Supplement Plan N will have similar benefits to Plan D, but there will be a $20 co-payment for doctor visits and a $50 co-payment for emergency room visits. It is believed that this co-pay will apply after the $135 deductible is paid. But there is some uncertainty as to how the deductible and co-pay will be applied. The good news is the cost of these plans is expected to have premiums around 70% of the cost of Plan F or about 77% of current plan D. Medicare Supplement Plan M will also offer similar benefits to Plan D, but will only cover 50% of the part A deducible and none of the part B deductible. The cost of Plan M is expected to price at approximately 85% of Plan F (or 92% of current plan D).
Industry experts are enthusiastic about these changes as consumers will be attracted by the lower premiums. As usual these plans were designed by academics’ with zero understanding of what consumers want and we're not certain the design fits exactly what consumers’ desire. I.e. these plans (M & N) don't include the $135 deductible nor do they include excess charges allowed by most states. However, we do expect the introduction of Medicare Supplement Plan M and Medicare Supplement Plan N along with other changes to provide a real opportunity for consumers. For plan information in your area go to Find Medicare Supplemental Insurance Plans. An internal consultant from the Senior Advisors Group will provide information on available plans, and answer questions about the best options and lowest premiums available in your area. (No salesman will visit your home)
Beginning June 1st, 2010 Medicare Supplemental Insurance (Medigap) will include two new choices for consumers - Medicare Supplement Plan M and Medicare Supplement Plan N.
At that time Medigap will eliminate plans E, H, I, and J as the "Preventive Care Benefit" and the "At-home-Recovery" benefit are removed. Once removed these plans – E, H, I, And J – will become identical to other lettered Medicare Supplement plans and thus redundant. Medicare has deemed these two benefits unnecessary in the current Medicare structure. In addition to these changes, a hospice care benefit Co-insurance coverage will be added to all new Medicare Supplement Plans.
Current Medicare Supplement policy holders will be permitted to keep existing Medicare Supplement Insurance policies, however as of June, 2010 enrollment will cease into ALL current plans. It is not necessarily beneficial to purchase one plan over another (purchase the one that fits) because all plans purchased after June 1st will be in the "New" Medicare Supplement Plan policy design. Existing Medicare Supplement policies (Policy holders) will be partitioned into one group and plans purchased after June will be partitioned into new policy groups. However, it is not certain that all Medicare Supplement (Medigap) providers will offer the new plans N and M, so a qualified, independent, advisor is suggested. Since most insurance carriers offer several plans it is important to shop around for the best price. (For more help go to Medicare Advisor)
An independent Medicare Supplement Advisor can assist you in finding a plan now; as well as help in 2010 when the new plans roll out. For individuals turning 65 before June 2010 the independent Advisor will be able to suggest a plan today as well as provide service and alternatives next year when the new plans and premiums become available. Company employed agents may not be the best solution as they can only suggest their companies plans. The Senior Advisors Group (Link) represents most plans in a given area and is very helpful in explaining the various options available today and the new plans coming next year. (including Medicare Advantage) Search Medicare Plans in your area
New Medigap Plan Design
Medicare Supplement Plan N will have similar benefits to Plan D, but there will be a $20 co-payment for doctor visits and a $50 co-payment for emergency room visits. It is believed that this co-pay will apply after the $135 deductible is paid. But there is some uncertainty as to how the deductible and co-pay will be applied. The good news is the cost of these plans is expected to have premiums around 70% of the cost of Plan F or about 77% of current plan D. Medicare Supplement Plan M will also offer similar benefits to Plan D, but will only cover 50% of the part A deducible and none of the part B deductible. The cost of Plan M is expected to price at approximately 85% of Plan F (or 92% of current plan D).
Industry experts are enthusiastic about these changes as consumers will be attracted by the lower premiums. As usual these plans were designed by academics’ with zero understanding of what consumers want and we're not certain the design fits exactly what consumers’ desire. I.e. these plans (M & N) don't include the $135 deductible nor do they include excess charges allowed by most states. However, we do expect the introduction of Medicare Supplement Plan M and Medicare Supplement Plan N along with other changes to provide a real opportunity for consumers. For plan information in your area go to Find Medicare Supplemental Insurance Plans. An internal consultant from the Senior Advisors Group will provide information on available plans, and answer questions about the best options and lowest premiums available in your area. (No salesman will visit your home)
Saturday, September 26, 2009
Health Care Reform - A Viable Solution
I have written in some length about the issues of the U.S. healthcare system and have attempted to cut through some of the rhetoric. You can read the preamble to this solutions only article at Healthcare Reform Compromise. For now a healthcare solution that is understandable and summarized in just a few short concepts. (Not 1,000 or so pages)
The following concepts specifically address the major issues facing the U.S. health delivery system. I have defined the major categories as: 1) Cost control 2) Minimize provider loss, 3) Reduce Insurance premiums 4) Provide catastrophic coverage for every American 5) Create an environment of affordable, manageable health delivery 6) Minimal added cost.
What follows is a 21st century, free market based, leadership solution. It is a foundation for a real solution, a place I believe many of us can agree.
Reform/Solutions:
1) A system that "Insures displaced workers" for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide a minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy the minimum coverage in that employer group for an unlimited time frame. Result, an individual will always have access to a group plan as long as premiums are paid. No pre-existing condition discrimination, and this specifically addresses the problem of the temporary uninsured and uninsurable.
The minimum standard coverage would include 2 parts: First, some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. This minimum required employer coverage would provide health insurance to roughly $500 per recipient or family member. This keeps the unemployed going to doctors and minimizes future catastrophic needs. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transferred to the new employer group and responsibility reassigned. (This would only apply to groups over some predetermined level i.e. 50 members) This would give the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as the premium was paid.
2) Minimize provider loss/Catatrophic Coverage for Every American: Specifically addressing a major burden on hospitals, and other providers by the uninsured. This is one of the major issues driving up the cost for the insured. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would bring every worker into the system including those wage earners with sufficient income to afford some coverage but skate by without health insurance. These individuals currently add cost by increasing risk, and utilizing expensive ER services for care. Those who have insurance end up covering this added cost with inflated cost of care, and higher premiums. This concept would be a positive revenue mechanism by bringing in those who currently pay nothing. (Specifically those 17 million who earn over $50,000/year but do not buy health insurance)
Important: Those currently insured will be rewarded as their new tax will be significantly offset by the reduction in their health insurance premiums. This will occur as the artificial inflation of services is reigned in, provider loses are mitigated, and the cost to insurance companies is reduced. With no risk above 250K insurers will be able to lower premiums as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). Note: Most insurance policies cover up to 2 million, 5 million, or even have unlimited benefit limits.
The total tax to those already insured would be offset - in time - by the savings. I'm confident this would be close to neutral in cost for those currently insured and it could exceed 100% offset as the added costs are borne predominately by those who can afford health insurance in the first place but choose to ignore the need.
As the individuals who ignore health insurance are brought into the system they can still avoid other coverage but the high burden they place on the system will be mitigated. Their newly captured tax pays for catastrophic coverage, and hospitals are relieved of the burden of losses above the 250k. In addition catastrophic costs and shared by every American and more important; Every foreign workers, illegal workers, and those irresponsible Americans earning sufficient wages but not contributing are integrated into the system.
Additional Results: Relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles. This point further addresses the uninsured however many would eventually become tied to some group plan. (above)
3) We need A National health Insurance Regulatory Agency so insurers who provide policies over several states could meet ONE regulatory requirement recognized by all 50 states. Large insurance plans would be overseen by 1 regulator instead of contending with up to 50 regulators in every state they do business. Regional providers that can do better on a local level would remain to drive out cost on a regional level. This would create an compettitive environment in which national plans would emerge strengthening competition, reducing overhead, exploiting synergies, and exploiting internal technology and infrastructure. This would ultimately reduce insurance cost. I can foresee consolidation potentially reducing options for individual so I would forbid any consolidation that would reduce the number of choices in any given area below 5 or more.
I would make the financial requirement significant in areas of capitalization, loss reserve, as well as other necessary standards. It would and should be tougher than any state so that there is no “systematic risk” in the event of any national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure.
An insurance "exchange" as is currently being discussed would be a sufficient alternative but I don't believe it will work. It is irrational to allow New Yorkers to buy insurance in Georgia or Indiana. How will an insurer be regulated in NY that may be based in Tennessee? It seems like it adds more – not less – bureaucracy, but I am open to suggestions.
4) “Cost control”: (The ugly and anti-free market dilemma) - The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. It has been demonstrated that this is an area where we could realistically apply responsibility over a group of multiple providers (Physicians, hospitals, and pharmaceutical providers) for the package treatment and healthcare. (Although not necessary.) The plan could include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.
I would allow providers and hospitals to balance bill (up to 15%) and/or opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group plans would have to include excess charges. However, “Gap” plans available to only unemployed individuals would not. Further, Individual plans would be available as including excess charges OR as HSA accounts and would require a minimum ($50/month) HSA contribution as a trade off. The benefit; The HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the obligation for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for future catastrophic expenses that entered the "excess" dimension. The insured would have the option to purchase these HSA plans or purchase plans that included the additional excess coverage.
Result: Under The new reform everyone but especially the younger American’s could accumulate (with HSA’s) 10's of thousands of dollars in their 20's, 30's, and 40's. This account could then be used later in life as health care needs become more likely. Additionally, the HSA could be used for the individual owner or family healthcare requirements. Eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. So individuals are now in control, saving for their own of family healthcare needs and in addition have an account that could pay LTC premiums later in life.
As many have wisely pointed out, when individuals use there own accounts they spend more wisely. Having ownership of a health plan from the age of 18, 21, or even later in life keeps individuals involved. Ultimately we’ll create an environment were everyone pays something, everyone gets something, and everyone has some level of affordable healthcare insurance. No excessive government intrusion necessary.
Some additional Details: Similar to our current environment HMO’s, PPO's, and other plan providers would still negotiate reimbursement of charges above the 250K catastrophic limit. The insurance provider would manage and make payments to facilities and others but would be reimbursed at the scheduled rates from the healthcare trust. This will control excessive inflation for high end health services but does not completely communize and thwart our free market system. Further we need to also reform HSA account use and expand premium tax deductions to individuals. Employer provided versions require users to spend down accounts each year. This is Dumb. We need to allow employer based MSA’s to accumulate over years.
Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the free-market environment present in the current hospital and provider system. Some providers will always be better than others. Experience and expertise will naturally accumulate in “pools” this is Nature at work and a working plan will have to accommodate the laws of nature.
In a later phase I MIGHT require all insurers to cover all applicants at some maximum rate. Say, 2x the base rate. Or, create some sort of national high risk pool and assign applicants to plans based on size and other factors. This would make health care coverage attainable to those few remaining high risk individuals. I would only consider this after several years and the impact of phase one of the health care reforms is evaluated. Another option is a “High risk” reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. Details on this portion world need to be worked out. Ultimately, most every worker would have access to a group plan from point 1
finnally, many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly there are additional issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the ground to be covered. (Pay attention Washington)
Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:
1) Do no harm
2) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms like online records etc. are the role of government - Not biased competition, or industry manipulation) You can apply for insurance online Example Aetna Health Insurance , but your doctor can't get test results or health history.
2) Improve the system for everyone. Society should provide a safety net for everyone including themselves. But it should be simple and just - No excessive burden on any class.
4) Find Common Ground – Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to only those specific areas on which we agree. If you don't understand the hidden costs of government involvement see Medicare’s Hidden Administrative Costs: by The Council for Affordable Health Insurance
Responsible government means specifically defining problems, outlining solutions, and analyzing reasonable outcomes. There needs to be sufficient time for review, withtime for debate and analysis.(30-60 days seems rational) Anything less is irresponsible.
Our Constitution was not completely ratified for 9 months and it took 3 months before the first state put its signature on the plan. The current rush into new programs is our current governments attempt to cloak the truth from the public. Our Government is a disgrace, and the absence of these principles is destroying our great country. We need to return to the place our founders created. (1, large page I might add)
The following concepts specifically address the major issues facing the U.S. health delivery system. I have defined the major categories as: 1) Cost control 2) Minimize provider loss, 3) Reduce Insurance premiums 4) Provide catastrophic coverage for every American 5) Create an environment of affordable, manageable health delivery 6) Minimal added cost.
What follows is a 21st century, free market based, leadership solution. It is a foundation for a real solution, a place I believe many of us can agree.
Reform/Solutions:
1) A system that "Insures displaced workers" for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide a minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy the minimum coverage in that employer group for an unlimited time frame. Result, an individual will always have access to a group plan as long as premiums are paid. No pre-existing condition discrimination, and this specifically addresses the problem of the temporary uninsured and uninsurable.
The minimum standard coverage would include 2 parts: First, some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. This minimum required employer coverage would provide health insurance to roughly $500 per recipient or family member. This keeps the unemployed going to doctors and minimizes future catastrophic needs. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transferred to the new employer group and responsibility reassigned. (This would only apply to groups over some predetermined level i.e. 50 members) This would give the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as the premium was paid.
2) Minimize provider loss/Catatrophic Coverage for Every American: Specifically addressing a major burden on hospitals, and other providers by the uninsured. This is one of the major issues driving up the cost for the insured. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would bring every worker into the system including those wage earners with sufficient income to afford some coverage but skate by without health insurance. These individuals currently add cost by increasing risk, and utilizing expensive ER services for care. Those who have insurance end up covering this added cost with inflated cost of care, and higher premiums. This concept would be a positive revenue mechanism by bringing in those who currently pay nothing. (Specifically those 17 million who earn over $50,000/year but do not buy health insurance)
Important: Those currently insured will be rewarded as their new tax will be significantly offset by the reduction in their health insurance premiums. This will occur as the artificial inflation of services is reigned in, provider loses are mitigated, and the cost to insurance companies is reduced. With no risk above 250K insurers will be able to lower premiums as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). Note: Most insurance policies cover up to 2 million, 5 million, or even have unlimited benefit limits.
The total tax to those already insured would be offset - in time - by the savings. I'm confident this would be close to neutral in cost for those currently insured and it could exceed 100% offset as the added costs are borne predominately by those who can afford health insurance in the first place but choose to ignore the need.
As the individuals who ignore health insurance are brought into the system they can still avoid other coverage but the high burden they place on the system will be mitigated. Their newly captured tax pays for catastrophic coverage, and hospitals are relieved of the burden of losses above the 250k. In addition catastrophic costs and shared by every American and more important; Every foreign workers, illegal workers, and those irresponsible Americans earning sufficient wages but not contributing are integrated into the system.
Additional Results: Relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles. This point further addresses the uninsured however many would eventually become tied to some group plan. (above)
3) We need A National health Insurance Regulatory Agency so insurers who provide policies over several states could meet ONE regulatory requirement recognized by all 50 states. Large insurance plans would be overseen by 1 regulator instead of contending with up to 50 regulators in every state they do business. Regional providers that can do better on a local level would remain to drive out cost on a regional level. This would create an compettitive environment in which national plans would emerge strengthening competition, reducing overhead, exploiting synergies, and exploiting internal technology and infrastructure. This would ultimately reduce insurance cost. I can foresee consolidation potentially reducing options for individual so I would forbid any consolidation that would reduce the number of choices in any given area below 5 or more.
I would make the financial requirement significant in areas of capitalization, loss reserve, as well as other necessary standards. It would and should be tougher than any state so that there is no “systematic risk” in the event of any national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure.
An insurance "exchange" as is currently being discussed would be a sufficient alternative but I don't believe it will work. It is irrational to allow New Yorkers to buy insurance in Georgia or Indiana. How will an insurer be regulated in NY that may be based in Tennessee? It seems like it adds more – not less – bureaucracy, but I am open to suggestions.
4) “Cost control”: (The ugly and anti-free market dilemma) - The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. It has been demonstrated that this is an area where we could realistically apply responsibility over a group of multiple providers (Physicians, hospitals, and pharmaceutical providers) for the package treatment and healthcare. (Although not necessary.) The plan could include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.
I would allow providers and hospitals to balance bill (up to 15%) and/or opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group plans would have to include excess charges. However, “Gap” plans available to only unemployed individuals would not. Further, Individual plans would be available as including excess charges OR as HSA accounts and would require a minimum ($50/month) HSA contribution as a trade off. The benefit; The HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the obligation for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for future catastrophic expenses that entered the "excess" dimension. The insured would have the option to purchase these HSA plans or purchase plans that included the additional excess coverage.
Result: Under The new reform everyone but especially the younger American’s could accumulate (with HSA’s) 10's of thousands of dollars in their 20's, 30's, and 40's. This account could then be used later in life as health care needs become more likely. Additionally, the HSA could be used for the individual owner or family healthcare requirements. Eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. So individuals are now in control, saving for their own of family healthcare needs and in addition have an account that could pay LTC premiums later in life.
As many have wisely pointed out, when individuals use there own accounts they spend more wisely. Having ownership of a health plan from the age of 18, 21, or even later in life keeps individuals involved. Ultimately we’ll create an environment were everyone pays something, everyone gets something, and everyone has some level of affordable healthcare insurance. No excessive government intrusion necessary.
Some additional Details: Similar to our current environment HMO’s, PPO's, and other plan providers would still negotiate reimbursement of charges above the 250K catastrophic limit. The insurance provider would manage and make payments to facilities and others but would be reimbursed at the scheduled rates from the healthcare trust. This will control excessive inflation for high end health services but does not completely communize and thwart our free market system. Further we need to also reform HSA account use and expand premium tax deductions to individuals. Employer provided versions require users to spend down accounts each year. This is Dumb. We need to allow employer based MSA’s to accumulate over years.
Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the free-market environment present in the current hospital and provider system. Some providers will always be better than others. Experience and expertise will naturally accumulate in “pools” this is Nature at work and a working plan will have to accommodate the laws of nature.
In a later phase I MIGHT require all insurers to cover all applicants at some maximum rate. Say, 2x the base rate. Or, create some sort of national high risk pool and assign applicants to plans based on size and other factors. This would make health care coverage attainable to those few remaining high risk individuals. I would only consider this after several years and the impact of phase one of the health care reforms is evaluated. Another option is a “High risk” reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. Details on this portion world need to be worked out. Ultimately, most every worker would have access to a group plan from point 1
finnally, many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly there are additional issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the ground to be covered. (Pay attention Washington)
Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:
1) Do no harm
2) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms like online records etc. are the role of government - Not biased competition, or industry manipulation) You can apply for insurance online Example Aetna Health Insurance , but your doctor can't get test results or health history.
2) Improve the system for everyone. Society should provide a safety net for everyone including themselves. But it should be simple and just - No excessive burden on any class.
4) Find Common Ground – Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to only those specific areas on which we agree. If you don't understand the hidden costs of government involvement see Medicare’s Hidden Administrative Costs: by The Council for Affordable Health Insurance
Responsible government means specifically defining problems, outlining solutions, and analyzing reasonable outcomes. There needs to be sufficient time for review, withtime for debate and analysis.(30-60 days seems rational) Anything less is irresponsible.
Our Constitution was not completely ratified for 9 months and it took 3 months before the first state put its signature on the plan. The current rush into new programs is our current governments attempt to cloak the truth from the public. Our Government is a disgrace, and the absence of these principles is destroying our great country. We need to return to the place our founders created. (1, large page I might add)
Thursday, June 18, 2009
Healthcare Compromise - The Uninsured and Problems Facing Healthcare
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Although there is room for improvement in our health care system, our current path will not solve the underlying problems and the facts don’t support the proposed solutions. We need reform but we don't need the confluence of bureaucracy and regulations currently under construction.
First let's examine some facts: It seems everyone agrees there are around 47-48 Million uninsured. Of that total the White House includes 9.7 million foreigners, (Many of those illegal). And, according to the same Census report, 8.3 million uninsured people earn between $50,000 and $74,999 per year, and 8.74 million make more than $75,000 a year. That’s roughly 17 million people who ought to be able to “afford” some health insurance, (they make substantially more than the median household income of $46,326). Further dissected: A 2003 Blue Cross/Blue Shield Association study estimated that about 14 million of the uninsured were eligible for Medicaid and/or SCHIP and would be signed up automatically if they went to the hospital. Technically these people have health insurance.
All-in that leaves 6.26 million Americans who are truly without health insurance. Hmmm, Should we spend 1 trillion dollars and completely alters the health care delivery, payment, and responsibility to satisfy 2% of the entire U.S. population? Along the way should we cut physician and hospital reimbursement for care. Does anyone believe cutting compensation will improve care? That's what is proposed.
Examining the uninsured population Further; 45% of the uninsured are "temporary". It's unclear which of the above categories they fall into. However, statistics show that these 20 million “temporary uninsured” are without insurance for an average of only 4 months. Sure "temporarily uninsured" is dangerous. Many go longer than 4 months, and if care is required during the temporary period it can cause significant financial damage to families and the institutions obligated to provide their care. This point needs to be addressed. However, the current solutions don’t specifically address these problems.
The unintended consequences of the proposed solution will be enormous. To rush into a social experiment of this magnitude without every reasonable outcome fully vetted and addressed is an experiment with potentially dire consequences with little chance of doing it again - properly.
Lastly; the issue of quality of care in the U.S. verses other countries. Anyone who doesn't inherently suspect this delusion should check their pulse; better yet their gut. This propaganda is distorted information from a study performed by the World Health Organization (WHO). Since my goal is facts and solutions I will sum up the report for the otherwise misinformed. The WHO report has several major factors that contribute to country rankings. One major factor is individual financial contributions to healthcare. The scoring method benefits those countries with higher levels of social (government) contributions. The result is a penalty effect on those countries with lower government expenditure. The bottom line is it would be nearly impossible for a country like the U.S. with a "free-market" health system to score high in the overall ranking.
The report is not an analysis of care (The U.S. ranks #1 in outcomes for 14 of 16 cancer treatments) but more an analysis of social contributions towards healthcare. The method used further penalizes the U.S. for higher homicide and motor vehicle deaths which have nothing to do with healthcare delivery. Bottom line the U.S. is #1 in healthcare not so high in government financial intrusion.
Now that we have some facts let’s examine where there may be some legitimate concerns, and address some specific areas for improvement.
The problems:
Rapidly rising cost, A growing burden on individuals, families, and employers to maintain premium payments, the inability of those with health issues to get health insurance, the temporary uninsured, and the 6.2 million that may require some legitimate support and safety net.
For the benefit of society we need some way to manage this group (33M) for the greater good of society as a whole. However, the reality is that there are options available today that would resolve a big chuck of these obstacles. What we need is reasonable fine tuning to maintain relevance to the modern economic environment - Not the 1950’s environment. For one, there are high deductible health saving accounts which have not been embraced by individuals. Millions of uninsured could afford these premiums ($75-100/month for average 40 year old) yet they opt for nothing. This is just irresponsible on the part of many and it affects us all when these people (earning over 50K/year) become ill, and transfer their burden to society.
Another significant factor driving up cost is the fragmented system of regulation on our current health insurance market. Simplifying this system, providing new health technology, modernized regulatory and oversight, and standardized infrastructure including claims forms etc. would drive out significant overhead, create synergies, improve productivity, increase competition, and further drive out waste and unnecessary spending. This is the only area where we should ever see government involvement in a capitalistic society. Creating infrastructure and a platform on which capitalism can thrive. (i.e. interstate transportation system)
Next; The high burden associated with the uninsured entering a hospital/emergency room that require treatment for life threatening injuries, or other high cost healthcare. Hospitals account for these services under the indigent care expense line in there budget and make up the loss by overcharging the insured.
The final factor is addressing the reality of the "truly uninsured". The burden (financial or otherwise) regardless of whether they are temporary, illegal, foreign, or have sufficient income - they must be dealt with. A real solution does not ignore reality nor should it jeopardize 250 million people to fix the problems of 6 million.
Solutions:
The following solutions will control cost, minimize lose expose, lower premiums, provide catastrophic coverage for every American, and create an environment of affordable health coverage to nearly every American with minimal added cost to existing insured individuals or business. What follows is a 21st century, free market based, U.S. world leadership solution.
1) A system that insures displaced worker for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide some minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy at least the minimum coverage in that employer group for an unlimited time frame. Result, they are able to stay in that group as long as premiums are paid!
The minimum standard coverage would include some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. I would limit this coverage to $500-$1000 per recipient or family member. This would keep people going to doctors and minimize future catastrophic needs. Also it gives the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as someone paid a reasonable premium. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transitioned to the new employer group and responsibility transferred.
2) We need a National health Insurance Regulatory Agency so insurers who provide policies over several states could meet ONE regulatory requirement that would be recognized by all states. I would make this requirement significant in areas of financial capitalization, loss reserve, as well as other necessary standards. It should be as tough or tougher as any state so that there is no “systematic risk” in the event of one national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure. This would create an environment in which national plans would emerge strengthening competition and reducing cost. Large insurance plans would not have to contend with 50 regulators, and regional providers that can do things better on a local level would remain and drive out cost on a regional level. An insurance "exchange" as is currently being discussed would be a sufficient alternative.
3) The burden of the uninsured on hospitals, and other providers. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would force every worker into the system including wage earners with sufficient income to afford some coverage but do not. These individual currently skate by increasing risk and cost to the system and every other insured American.
As these individuals are forced into the system, at least they have coverage above 250,000. Hospitals are relieved of the burden of losses above the 250k. The catastrophic burden is shared by every Americans and foreign workers. Those currently insured are rewarded when the artificial inflation of services is reigned in and provider loses are mitigated. This will result in some reductions in health insurance premiums, offsetting at least some portion of the tax paid. Additional premium reductions would occur since most insurance policies cover up to 2 million, 5 million, or more. Those who currently have health insurance would see further premium reductions as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). The total tax to those already insured would in theory could be offset in time by the savings. But I’m not banking on 100% return. Their will be technology cost but the added costs will be borne predominately by those who can afford the coverage in the first place but choose to ignore the need.
Additional benefits: relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles.
“Cost control” - The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. An area where we could realistically apply responsibility over a group for the treatment and healthcare of one. The plan could (And should) include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.
I would allow providers and hospitals to balance bill (up to 15%) and opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group and individual “comprehensive” plans would have to include excess charges. However “Gap” plans (one that paid up to the 250K cat coverage) would not. These plans would only be available as HSA accounts and would include a minimum ($50/month) HSA contribution. The trade off here is the HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the trade off for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for catastrophic expenses that went into the "excess" dimension. The insured would have the option to purchase these hybrid HSA plans or purchase plans that included the additional excess coverage.
I would find ways to stimulate HSA account use and expand premium tax deductions to individuals. The employer provided version requires users to spend down these accounts each year. This is Dumb. If we allow HSA plans (like the individual purchased version) to accumulate over years. Then (under new reform) the 20 somethings forced into the system with HSA could accumulate 10's of thousands of dollars in the 20's and 30's which could be used later in life as health care needs become more likely. As many have stated when individuals use there own accounts they spend more wisely. Having ownership of a plan from the age of 18 or 21 would keep people involved. This could be used for health care not covered under catastrophic plans, or other low cost high deductible options. Later in life it could be used for individual or family healthcare and eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. ultimately we have created an environment were everyone pays in something, everyone gets out something and everyone has some level of affordable healthcare insurance. No government intrusion necessary.
Similar to our current environment HMO’s and other insurers would still negotiate reimbursement of excess charges above the 250K catastrophic limit. This would look similar to the way private plans negotiate and reimburse providers under Medicare.
Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the environment present in the current hospital and provider system. Some providers will always be better than others. The major difference would be some might have the insurance coverage to pay the excess bill were others would be responsible to pay some out of pocket or get treatment from another high quality provider.
In a later phase I MIGHT require all insurers to cover all applicants at a maximum of 2x the base rate. Or create some sort of high risk pool. This would make health care coverage attainable to those remaining high risk individuals. I would only consider this after 5 years and the impact of phase one of the health care reforms I have proposed is evaluated. The other option is a High risk reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. (Details on this portion another time)
Many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly these are issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the area to be covered.
The bottom line for Americans...Cuts to Medicare. Seniors should be outraged! Taxes on Premiums, Families should be outraged! Penalties (taxes) on business hurting the heart of the countries economic engine. Everyone should be outraged! Obama lied to us about taxes. He is going to wipe out economic growth and bankrupt this country. Wake up America. This plan will not solve any of the challenges facing the health care industry. It we be just another tax hike that we were assured would not occur. 1st the cigarette tax, next, the proposed energy tax, and now the healthcare tax. You can be sure that there will be some hidden and some not so hidden taxes paid by every American. Don't believe that some Voodoo savings over there will pay for this new program over here. They are misleading you. These are mostly outright lies and deception because they don't want you to know the truth.
Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:
1) Do No Harm
2) Improve the system for everyone in it. Society should provide a safety net, but it should be simple and just - No excessive burden on any class.
3) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms are the role of government - Not biased competition) If you don't understand the hidden costs of government involvement you're in over your head - Read this next.
4) Find Common Ground – Horse trading does not work in Politics. Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to specific areas on which there is agreement.
Responsible government means specifically defining problems, outline solutions, and analyze every reasonable outcome. There needs to be sufficient time for review before instituting reform. 30-60 days seems rational time for debate and analysis. Anything less is irresponsible. The current rush into new programs is our governments attempt to cloak what is happening from the public. It is a disgrace, and the public is lazily culpable for allowing this to occur.
The absence of these principles is destroying our great country.
Although there is room for improvement in our health care system, our current path will not solve the underlying problems and the facts don’t support the proposed solutions. We need reform but we don't need the confluence of bureaucracy and regulations currently under construction.
First let's examine some facts: It seems everyone agrees there are around 47-48 Million uninsured. Of that total the White House includes 9.7 million foreigners, (Many of those illegal). And, according to the same Census report, 8.3 million uninsured people earn between $50,000 and $74,999 per year, and 8.74 million make more than $75,000 a year. That’s roughly 17 million people who ought to be able to “afford” some health insurance, (they make substantially more than the median household income of $46,326). Further dissected: A 2003 Blue Cross/Blue Shield Association study estimated that about 14 million of the uninsured were eligible for Medicaid and/or SCHIP and would be signed up automatically if they went to the hospital. Technically these people have health insurance.
All-in that leaves 6.26 million Americans who are truly without health insurance. Hmmm, Should we spend 1 trillion dollars and completely alters the health care delivery, payment, and responsibility to satisfy 2% of the entire U.S. population? Along the way should we cut physician and hospital reimbursement for care. Does anyone believe cutting compensation will improve care? That's what is proposed.
Examining the uninsured population Further; 45% of the uninsured are "temporary". It's unclear which of the above categories they fall into. However, statistics show that these 20 million “temporary uninsured” are without insurance for an average of only 4 months. Sure "temporarily uninsured" is dangerous. Many go longer than 4 months, and if care is required during the temporary period it can cause significant financial damage to families and the institutions obligated to provide their care. This point needs to be addressed. However, the current solutions don’t specifically address these problems.
The unintended consequences of the proposed solution will be enormous. To rush into a social experiment of this magnitude without every reasonable outcome fully vetted and addressed is an experiment with potentially dire consequences with little chance of doing it again - properly.
Lastly; the issue of quality of care in the U.S. verses other countries. Anyone who doesn't inherently suspect this delusion should check their pulse; better yet their gut. This propaganda is distorted information from a study performed by the World Health Organization (WHO). Since my goal is facts and solutions I will sum up the report for the otherwise misinformed. The WHO report has several major factors that contribute to country rankings. One major factor is individual financial contributions to healthcare. The scoring method benefits those countries with higher levels of social (government) contributions. The result is a penalty effect on those countries with lower government expenditure. The bottom line is it would be nearly impossible for a country like the U.S. with a "free-market" health system to score high in the overall ranking.
The report is not an analysis of care (The U.S. ranks #1 in outcomes for 14 of 16 cancer treatments) but more an analysis of social contributions towards healthcare. The method used further penalizes the U.S. for higher homicide and motor vehicle deaths which have nothing to do with healthcare delivery. Bottom line the U.S. is #1 in healthcare not so high in government financial intrusion.
Now that we have some facts let’s examine where there may be some legitimate concerns, and address some specific areas for improvement.
The problems:
Rapidly rising cost, A growing burden on individuals, families, and employers to maintain premium payments, the inability of those with health issues to get health insurance, the temporary uninsured, and the 6.2 million that may require some legitimate support and safety net.
For the benefit of society we need some way to manage this group (33M) for the greater good of society as a whole. However, the reality is that there are options available today that would resolve a big chuck of these obstacles. What we need is reasonable fine tuning to maintain relevance to the modern economic environment - Not the 1950’s environment. For one, there are high deductible health saving accounts which have not been embraced by individuals. Millions of uninsured could afford these premiums ($75-100/month for average 40 year old) yet they opt for nothing. This is just irresponsible on the part of many and it affects us all when these people (earning over 50K/year) become ill, and transfer their burden to society.
Another significant factor driving up cost is the fragmented system of regulation on our current health insurance market. Simplifying this system, providing new health technology, modernized regulatory and oversight, and standardized infrastructure including claims forms etc. would drive out significant overhead, create synergies, improve productivity, increase competition, and further drive out waste and unnecessary spending. This is the only area where we should ever see government involvement in a capitalistic society. Creating infrastructure and a platform on which capitalism can thrive. (i.e. interstate transportation system)
Next; The high burden associated with the uninsured entering a hospital/emergency room that require treatment for life threatening injuries, or other high cost healthcare. Hospitals account for these services under the indigent care expense line in there budget and make up the loss by overcharging the insured.
The final factor is addressing the reality of the "truly uninsured". The burden (financial or otherwise) regardless of whether they are temporary, illegal, foreign, or have sufficient income - they must be dealt with. A real solution does not ignore reality nor should it jeopardize 250 million people to fix the problems of 6 million.
Solutions:
The following solutions will control cost, minimize lose expose, lower premiums, provide catastrophic coverage for every American, and create an environment of affordable health coverage to nearly every American with minimal added cost to existing insured individuals or business. What follows is a 21st century, free market based, U.S. world leadership solution.
1) A system that insures displaced worker for up to one year. Most individuals look at COBRA through the lens of unemployment and conclude that it’s unaffordable. Of course they do; they’re unemployed. Employers should be required to provide some minimum level of health insurance for 12 months after unemployment. After year 1 the displaced employee could choose to buy at least the minimum coverage in that employer group for an unlimited time frame. Result, they are able to stay in that group as long as premiums are paid!
The minimum standard coverage would include some preventative and basic health care. i.e. 2 doctors visits annually plus some diagnostic coverage benefit. I would limit this coverage to $500-$1000 per recipient or family member. This would keep people going to doctors and minimize future catastrophic needs. Also it gives the unemployed or those doing other work access to a group health plan. Anyone who has at least one job in life would have coverage as long as someone paid a reasonable premium. The second part of the minimum requirement would be catastrophic coverage over $100,000 to the $250,000 threshold. Individuals could have the option to purchase “gap” coverage to fill in between $500 and $100,000 if they choose. Once employed again the individual would be transitioned to the new employer group and responsibility transferred.
2) We need a National health Insurance Regulatory Agency so insurers who provide policies over several states could meet ONE regulatory requirement that would be recognized by all states. I would make this requirement significant in areas of financial capitalization, loss reserve, as well as other necessary standards. It should be as tough or tougher as any state so that there is no “systematic risk” in the event of one national provider failure. Essentially, it should be tough enough to almost eliminate the possibility of failure. This would create an environment in which national plans would emerge strengthening competition and reducing cost. Large insurance plans would not have to contend with 50 regulators, and regional providers that can do things better on a local level would remain and drive out cost on a regional level. An insurance "exchange" as is currently being discussed would be a sufficient alternative.
3) The burden of the uninsured on hospitals, and other providers. I would impose an off budget, segregated, “Lock box” type trust fund that could not be borrowed from EVER. A small tax on wages would provide for catastrophic coverage over a $250,000 threshold for every American. Since this would be a separate tax on income (over federal poverty level) it would force every worker into the system including wage earners with sufficient income to afford some coverage but do not. These individual currently skate by increasing risk and cost to the system and every other insured American.
As these individuals are forced into the system, at least they have coverage above 250,000. Hospitals are relieved of the burden of losses above the 250k. The catastrophic burden is shared by every Americans and foreign workers. Those currently insured are rewarded when the artificial inflation of services is reigned in and provider loses are mitigated. This will result in some reductions in health insurance premiums, offsetting at least some portion of the tax paid. Additional premium reductions would occur since most insurance policies cover up to 2 million, 5 million, or more. Those who currently have health insurance would see further premium reductions as the liability above 250K is transferred from insurance companies to the trust fund (could be phased in once the trust fund is in place). The total tax to those already insured would in theory could be offset in time by the savings. But I’m not banking on 100% return. Their will be technology cost but the added costs will be borne predominately by those who can afford the coverage in the first place but choose to ignore the need.
Additional benefits: relaxed underwriting standards, (insurer would be more willing to accept some riskier applicants since exposure is limited). This expands the availability of reasonably priced health insurance for those with preexisting conditions and/or elevated risk profiles.
“Cost control” - The government could create a reimbursement rate for services provided above the catastrophic amount controlling expenditures at the high end. This would be applied to high cost treatment and procedures only. An area where we could realistically apply responsibility over a group for the treatment and healthcare of one. The plan could (And should) include BONUSES for quality of care, outcomes, and other health performance criteria that many advocate.
I would allow providers and hospitals to balance bill (up to 15%) and opt out of the catastrophic coverage system altogether (not likely since they would be exposed to loses when any uninsured presented in their emergency room and they were mandated to provide service) ALL group and individual “comprehensive” plans would have to include excess charges. However “Gap” plans (one that paid up to the 250K cat coverage) would not. These plans would only be available as HSA accounts and would include a minimum ($50/month) HSA contribution. The trade off here is the HSA contribution would belong to the specific individual but could only ever be used for healthcare. This is the trade off for purchasing individual coverage without the “excess” coverage feature. Theoretically the HSA owner would be saving for catastrophic expenses that went into the "excess" dimension. The insured would have the option to purchase these hybrid HSA plans or purchase plans that included the additional excess coverage.
I would find ways to stimulate HSA account use and expand premium tax deductions to individuals. The employer provided version requires users to spend down these accounts each year. This is Dumb. If we allow HSA plans (like the individual purchased version) to accumulate over years. Then (under new reform) the 20 somethings forced into the system with HSA could accumulate 10's of thousands of dollars in the 20's and 30's which could be used later in life as health care needs become more likely. As many have stated when individuals use there own accounts they spend more wisely. Having ownership of a plan from the age of 18 or 21 would keep people involved. This could be used for health care not covered under catastrophic plans, or other low cost high deductible options. Later in life it could be used for individual or family healthcare and eventually it could be applied toward LTC premiums after age 55. That would solve ANOTHER problem facing the U.S. healthcare system. ultimately we have created an environment were everyone pays in something, everyone gets out something and everyone has some level of affordable healthcare insurance. No government intrusion necessary.
Similar to our current environment HMO’s and other insurers would still negotiate reimbursement of excess charges above the 250K catastrophic limit. This would look similar to the way private plans negotiate and reimburse providers under Medicare.
Although the “excess” billing option creates an environment of complexity to this solution it allows some sensible variations in pricing and regional cost variations. At the same time it does not create a system that encourage providers to “excess bill” and individuals to avoid the coverage. The result may be some high end clinics, hospitals and providers, but this is no different to the environment present in the current hospital and provider system. Some providers will always be better than others. The major difference would be some might have the insurance coverage to pay the excess bill were others would be responsible to pay some out of pocket or get treatment from another high quality provider.
In a later phase I MIGHT require all insurers to cover all applicants at a maximum of 2x the base rate. Or create some sort of high risk pool. This would make health care coverage attainable to those remaining high risk individuals. I would only consider this after 5 years and the impact of phase one of the health care reforms I have proposed is evaluated. The other option is a High risk reimbursement for those who have been denied coverage from 2 of more insurance providers. They would pay 2x the base rate from a provider of their choice and the government would kick in the balance necessary for the provider to take in the previously denied applicant. (Details on this portion another time)
Many readers might retort that I overlooked items such as Malpractice Insurance and caps on lawsuits. I trust you I did not. Certainly these are issues that need addressing but healthcare reform should not be confused with other reform. We must find common ground and that sometimes means shrinking the area to be covered.
The bottom line for Americans...Cuts to Medicare. Seniors should be outraged! Taxes on Premiums, Families should be outraged! Penalties (taxes) on business hurting the heart of the countries economic engine. Everyone should be outraged! Obama lied to us about taxes. He is going to wipe out economic growth and bankrupt this country. Wake up America. This plan will not solve any of the challenges facing the health care industry. It we be just another tax hike that we were assured would not occur. 1st the cigarette tax, next, the proposed energy tax, and now the healthcare tax. You can be sure that there will be some hidden and some not so hidden taxes paid by every American. Don't believe that some Voodoo savings over there will pay for this new program over here. They are misleading you. These are mostly outright lies and deception because they don't want you to know the truth.
Before we continue on any such reform we should keep a few simple principles at the top of any government reform package including healthcare:
1) Do No Harm
2) Improve the system for everyone in it. Society should provide a safety net, but it should be simple and just - No excessive burden on any class.
3) Minimize government involvement (infrastructure, regulatory platforms, and technology platforms are the role of government - Not biased competition) If you don't understand the hidden costs of government involvement you're in over your head - Read this next.
4) Find Common Ground – Horse trading does not work in Politics. Effective legislation can only be accomplished when we find areas of agreement and commit to legislation directed to specific areas on which there is agreement.
Responsible government means specifically defining problems, outline solutions, and analyze every reasonable outcome. There needs to be sufficient time for review before instituting reform. 30-60 days seems rational time for debate and analysis. Anything less is irresponsible. The current rush into new programs is our governments attempt to cloak what is happening from the public. It is a disgrace, and the public is lazily culpable for allowing this to occur.
The absence of these principles is destroying our great country.
Monday, March 9, 2009
Doylestown nonprofit helps Medicare reduce costs
This post is merely a comment on the article referenced above. To read article following link to the York Daily record.
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It sounds clear that it’s not “Managed Care” that has been the problem it has been “Management”. Clearly a properly designed, implemented and managed program can reduce cost.
We don’t need a new system, just a few improvements to our current system. I’ve been advocating for improvements we can believe in, not change for change sake. That will just add cost as we find new problems that they themselves need improving. And nothing has really gotten better, just different.
Take Medicare Advantage. Many of these plans are providing improved benefits, lower cost, and small co-pays for doctors’ visits and hospitalization. They are a great improvement over the old, tired, Original Medicare plan. Plans in many areas have very low co-pays for PCP visits. This low co-pay encourages low, middle income beneficiaries to see a doctor early and more often - improving the likelihood of catching a costly ailment early, saving money, and improving overall health. I we could take some of the lesson learned from this program and apply them to private Medicare, or Medicare Advantage we could really make health care better. Sure I hear the argument that these plans cost more. Well this program shows that it doesn’t have to be that way. We can do it for less.
Eliminating MA would just hurt low and middle income beneficiaries who in many cases can’t afford a Medicare Supplement Insurance . Let’s fix the problems say 1:1 reimbursement and let Capitalism and programs described in this article decide which is better.
-
It sounds clear that it’s not “Managed Care” that has been the problem it has been “Management”. Clearly a properly designed, implemented and managed program can reduce cost.
We don’t need a new system, just a few improvements to our current system. I’ve been advocating for improvements we can believe in, not change for change sake. That will just add cost as we find new problems that they themselves need improving. And nothing has really gotten better, just different.
Take Medicare Advantage. Many of these plans are providing improved benefits, lower cost, and small co-pays for doctors’ visits and hospitalization. They are a great improvement over the old, tired, Original Medicare plan. Plans in many areas have very low co-pays for PCP visits. This low co-pay encourages low, middle income beneficiaries to see a doctor early and more often - improving the likelihood of catching a costly ailment early, saving money, and improving overall health. I we could take some of the lesson learned from this program and apply them to private Medicare, or Medicare Advantage we could really make health care better. Sure I hear the argument that these plans cost more. Well this program shows that it doesn’t have to be that way. We can do it for less.
Eliminating MA would just hurt low and middle income beneficiaries who in many cases can’t afford a Medicare Supplement Insurance . Let’s fix the problems say 1:1 reimbursement and let Capitalism and programs described in this article decide which is better.
Monday, January 19, 2009
Medicare Supplemental Insurance
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Many people ask me "What is the best Medicare Supplemental Insurance"? My answer is always buy what you can afford.
The reason I say this is because the best plan is one that is affordable and will be affordable to maintain for the balance of ones life. If the premium is a burden at 65 then it's likely to be worse at 85 when it is likely you will need it most. So my first bit of advice is purchase a plan that you expect to comfortably maintain the premium payments for the rest of your life.
That said a cost/benefit analysis of some different options might be in order. One basic yet common analysis between a plan "A" vs. plan "J" for a specific (undefined) zip code for a Male turning 65. (Medicare Supplemental Insurance Comparison Chart) Your specific zip code will be different.
Premium Plan "A" = $ 99.79
Premium Plan "J" = $143.11
_____________________
Annual Savings $519.84
Painting with a broad brush assume you will have $150 in out of pocket cost each year by choosing "Plan A" over "Plan J". Your savings is reduced to $369.84/year. This also assumes no significant illness or hospitalization. Over 10 years thats ONLY $3,698.40 in saving. One hospital stay or significant illness would cost at least half that (2009 medicare deductibles)
So, my conclusion and answer is if it's affordable, purchase a Medicare Plan J as soon as possible. Ideally this would be obtained as you are enrolled in Medicare Part B, (Age 65 unless covered under an employer plan). During the first 6 month of obtaining Medicare Part B you have guaranteed acceptance in a Medicare Supplement plan regardless of your health.
You will also need to add a Medicare Rx plan to cover your prescription drugs, which will add roughly $25-$50/month. If this starts to get dauting call a Advisor
You can also request quotes and free consultation on Medicare Supplement plans at Medicare Supplement Consultation, or get Medicare Supplemental Insurance quotes for your zip code.
Happy Retirement!
Many people ask me "What is the best Medicare Supplemental Insurance"? My answer is always buy what you can afford.
The reason I say this is because the best plan is one that is affordable and will be affordable to maintain for the balance of ones life. If the premium is a burden at 65 then it's likely to be worse at 85 when it is likely you will need it most. So my first bit of advice is purchase a plan that you expect to comfortably maintain the premium payments for the rest of your life.
That said a cost/benefit analysis of some different options might be in order. One basic yet common analysis between a plan "A" vs. plan "J" for a specific (undefined) zip code for a Male turning 65. (Medicare Supplemental Insurance Comparison Chart) Your specific zip code will be different.
Premium Plan "A" = $ 99.79
Premium Plan "J" = $143.11
_____________________
Annual Savings $519.84
Painting with a broad brush assume you will have $150 in out of pocket cost each year by choosing "Plan A" over "Plan J". Your savings is reduced to $369.84/year. This also assumes no significant illness or hospitalization. Over 10 years thats ONLY $3,698.40 in saving. One hospital stay or significant illness would cost at least half that (2009 medicare deductibles)
So, my conclusion and answer is if it's affordable, purchase a Medicare Plan J as soon as possible. Ideally this would be obtained as you are enrolled in Medicare Part B, (Age 65 unless covered under an employer plan). During the first 6 month of obtaining Medicare Part B you have guaranteed acceptance in a Medicare Supplement plan regardless of your health.
You will also need to add a Medicare Rx plan to cover your prescription drugs, which will add roughly $25-$50/month. If this starts to get dauting call a Advisor
You can also request quotes and free consultation on Medicare Supplement plans at Medicare Supplement Consultation, or get Medicare Supplemental Insurance quotes for your zip code.
Happy Retirement!
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